Is breast cancer overdiagnosed or isn’t it? The argument goes on

People taking sides in the mammography debates have a fresh controversy to feed on. This one has some Ivy League heft—and a pointed statement from the American College of Radiology—behind it.

Last week the New England Journal of Medicine published an opinion piece penned by two Dartmouth doctors and a special report by two Yale Cancer Center physicians.

Both papers advanced positions on avoiding cancer overdiagnosis.

Screening mammography “causes considerable overdiagnosis” and its “effectiveness is limited,” wrote Donald Lannin, MD, and Shiyi Wang, MD, PhD, of Yale. “Because of the long lead times, mammography is very good at detecting tumors with favorable biologic features, and therefore these tumors are overrepresented among small tumors. However, many of them do not progress within the patient’s lifetime; therefore, they contribute substantially to overdiagnosis.”

“Although it’s possible that [favorable] mortality trends can be explained by higher rates of screening resulting in fewer cancer deaths in high-income counties, such a benefit would have come at a cost—using these data, 5 to 10 overdiagnosed patients for every death averted,” wrote H. Gilbert Welch, MD, MPH, and Elliott Fisher, MD, MPH, of Dartmouth. (They looked at, but didn’t limit their case to, the place of breast cancer in general cancer overdiagnosis.)

The ACR posted a statement that read, in part:

“[M]any breast cancer opinions stated in the Welch-Fisher perspective and the Lannin-Wang special report on overdiagnosis, survival and screening vs. treatment effectiveness are refuted by direct patient data in respected studies. These two papers … are based on assumptions, many of which are unsupported, rather than direct patient data and should not affect breast cancer screening policy.”